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HomeMy WebLinkAboutPETERS GATE BLK 1 LT 3 MUNICIPALITY OF Ar+I HO AGE j%N un 1 On-�Sd[a Water & WastewAier Program �o� - fF PO PIM 91'61550 4T01} flmrrC F _ .rL i An r.. A4•� M1SLaH0 Phone: 17) 343-79GA Fax: �9DF] 343-?rij' Friry:�,rruv,.rnursi�ar�ol>�!e "ir On -Site Wastewater Disposal System Permit POMIt Number_ 0SP211412 Fffecfiwe Date: RWW21 Work 1We- se mTartk Upgrade Expiration Date- 072 Tax Code Nurnher- (151 54123000 Site Legal Address= PETERS GATE BL.K 1 LT 3 G_ 12E2 Site Mailing Address= 1 X41 THORNTON 5T, Chugiak Owner- CARLSON TCDD f� & J ENN IFER S Lot Sizer i rt 5q Ft- 55821 Desig n Eengi nleer- Carlson Sam Tota I Bedrooms: 3 This PerrkMliR iS fbr the Cvrl5trU tjOn of: 13 Dlsporal Field Z 8opUr, Tank 0 Holding Tank 0 Privy © Pm+atc was a WWW Storage All conshuction' Shall he in acC0rd:a*M with_ 1- The atLochad appror43d design- 2- All requireawmM :�perified in Anchorage Munirjp4l M60 C apters 15,55 old I5j85 and the Stat -0 of AIa WastOwater Di5powl Regulations and ilDrinFkirbg Vater R-agul;9 iigns (18AACW) 3- The W aVew;00r code requires Inspection during the iristallatii m. T;he erngirra-ar shvi1 rKyffy+ the Developmeni ,�ices Deparlr )wl por AMC 15,05- Provide ruAfication t)y calling (-JO7) 343.7004 (24U)- 4- From 00bbcr 15 tQ April 15. -a!SLFbsurrace soil absorptibn system ue7dcr WnstrucHon daring fmuzirtq weather srtao be either, a Opened and Closed on the same day. 4Dr b- Covered, !3"I(Idr and heated W pmvent f ee7jng Special Provisions: The tank es to be installed inn darer than 5 to tho deck stports. " Th:a d6ck wppurts are to ba shown on the reomd drawings- Jndudl� dimensions frim the Link to the strppartS. R4�Ceived By - ls!swod By: Date: f��a ZE,;�j -Date: j MLUH CSF A L 0 T Y OF t`\,Mi C�'=J 0 w Development Services Department ®Phone: 907-343-7904 4 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-54-123 Property owner(s) Todd and Jennifer Carlson Mailing address PO Box 670873 Chugiak, AK 99567 Site address 19801 Thornton Street, Chugiak, AK 99567 Day phone 688-5173 Legal description (Sub'd., Block & Lot) Lot 3 Block 1 of Peters Gate Subdivision,per plat 74-146 F.R.D. Legal description (Township, Range & Section) T1 5N R1 W S11 Lot Size 55321 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) Q ADU) Septic Tank n Upgrade El(w/wo Duplex (D) ❑ Holding Tank ElRenewal Q Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: No waiver requested Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. C"— �. Com.` ------ (Signature ofjp'roperty owner or authorized agent) Permit/Rush Fees: � '� (0 0 Waiver Fees: Date of Payment: Receipt Number: Permit No. QST a I I L' 1 Date of Payment: Receipt Number: Waiver No. GADevelopment Services\Building Safety\on Site Water and Wastewater\Forms\Client FormsTermit Application.doc DATUM PROFESSIONAL September 22, 2021 Municipality of Anchorage Development Service Department On -Site Water and Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Re: Proposed Septic Tank Replacement for Lot Lot 3 Block 1 of Peters Gate Subdivision To whom it may concern: The subject lot, also described as PID: 051-541-23-000 is a three bedroom residence served by a private well, and private conventional on-site septic system. The existing septic tank is a 1,000 gallon 2 -part steel septic tank that was installed in 1993. Recent pumping reports suggest foreign debris (rocks and gravel) have been introduced into the system through rusted sidewalls of the tank, and a visual inspection of the inside show that the structural integrity of the tank has been compromised. As such, I propose the tank to be replaced. The existing tank will be removed from the site, and a new tank will be placed in the same location. The new tank will be a = 2 -part plastic septic tank made by Greer with 1,250 gallon capacity rated for 10' burial depth, as the owners requested to upsize the tank for possible future addition of a fourth bedroom inside the residence. See attached drawings for tank location and other MOA requirements. No adverse impacts to adjacent wells or septic systems are expected at this time. Please contact myself at 907-699-6672 with questions or concerns. Sincerely, Sam Carlson, PE Datum Professional LLC Datum Professional LLC 1 DatumAK.com 1907.699.6672 PtAty-'0 D--A O O --1 I xAZzz M-1000 i O � � � z0 (S 89'57'45" E 225.00') N - ofA� .. O O W °�"Do ����... 49m I :Ell 63 \A( .......T.c.o._.r.4.0. .. F( VI�. 40-VI PRIVATE ........ . ..........:.. I M WELL \ '- Sam T, Carlson .•� j G7 i rn m _ I fir •. CE 114176 w Z I G� dt�•.9-23-2021 .:.�,� AW �F��RGrESSRO�`�� I , M o m o G LOT 3 BLOCK 1 O z o 1.27 AC. 0 Ci I o _ ON X� _ P w M co _I ;u Q O O I O \ N (On,n 0 / l 0 I O CD Z cn — EXISTING DEEP I RK�NG TRENCH PP \ WATERLINE PENETRATION I M _ TO HOUSE FROM WELL. 8 12' FROM NORTH CORNER CCfn) 5' DECK, LESS I < ,^� THAN 30" TALL �. OF HOUSE. -Cn 100 WELL 4� —/ m e RADIUS i ���__ 00 �jr do z EXISTING DOUBLE m I I o CLEANOUT EXISTING 1000 GALLON STEEL TANK,ACCESSIBLE FOUNDATION m TO BE REPLACED WITH 1250 GALLON CLEANOUT 2 PART GREER PLASTIC TANK NOTES: (N 89'57'45" W 225.00') 1. NEW TANK WILL BE 2 PART GREER PLASTIC 1250 GALLON. 2. TANK WILL BE INSTALLED MINIMUM 10' FROM FOUNDATION. 3. MOA APPROVED WATER TIGHT COUPLINGS WILL BE USED ON TANK RISERS AND THE INLET/ OUTLET. 4. PIPE MATERIALS WILL BE IN ACCORDANCE WITH MOA STANDARDS. 5. A 24" MANHOLE RISER WILL BE INSTALLED ON THE FIRST COMPARTMENT OF THE TANK. THE RISER WILL BE INSULATED WITH 4" MOA APPROVED INSULATION. AS-BUILT DRAWING OF: 0 40 80 SCALE: 1"=40 FEET DATE: 9/23/2021 FILE: 2107 19801 LOT 3 BLOCK 1 PROPERTY ADDRESS: 19801 Thornton Street, Chugick AK 99567 LEG DESC: Lot 3 Block 1 Peters Gate Subdivision, Plat: 74-146 F.R.D. PETERS GATE SUBDIVISION 539 PROSPECTORS TRAIL FAIRBANKS, AK 99712 PHONE: 907-699-6672 SolarWorks! Hawaii Fax:808-929-985& Feb 9 '99 12:55 P. O1 PH: 688-1236 P. O. BOX 670:~51 FAX: 688-1.2;}8 January 28, 1999 Mr. Gary Prokosch Department of Natural Resources 3601 C Street, Suite 800 Anchorage, Alaska 99503 RECEIVED FEB 9 199 Municipality ot Ancrtorage Oept, Health & Human'Servioee Re: Well at 'I 9801. Sullins Drive in Peters Gate Subdivision Dear M'r. Prok.osch: In a phone conversation you told me it was verified by a well driller that Jennifer Carlson's well had no perforations at 8' on her well casing which is against state law. As I had written DNR had installed a bleed offat 8' to bleed excess water offoftheir artesian well which is strictly prohibited by State law as wasting water, it is also against Municipal code for health reasons. Now after almost a year in following this up I find out that there was no verification whatsoever. You just had a telephone conversation wi.th Jennifer Carlson where she stated that they did not have a perforation in there well. and verified by a copy of the original well log. I am astounded that there was no written letter by a certified well technician to verify that there was no perforation. I know for a fact that Jennifer Carlson's well was artesian when it was drilled, you have a copy of the well log showing this, I know for a fact thai a perforation for draining water off their artesian well was installed at the request of the Carlson' s. I feel very strongly about the waste of water, I also feel very strongly about people misrepresenting things and that it is your job to properly verify and follow this up and document it. As you will recall your letter of September 8, 1997 gave Jennifer Carlson 60 days to correct the perfbration in her well, that was over a year ago, I would think any well technician could verify this easily and send you a letter. You had a man go out and inspect my well at the request of Jennifer Carlson while we had been doing testing of our artesian well we had been running water, we totally admit to this. We also installed a plug in our well at your request to stop the excess flow of water, You can trust us to deal honestly with you. Your sincere effort is appreciated on this matter. Sincerely, Paul Myers~~''~ Cc~ Mayor Ricl~ Mystrom Commissioner John Shively J'im Cross, HHS Municipality of Anchorage Page } of ~ .... DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: .~_,.~.~D ~! ~.~- PID Number: o~! ~-~1 N~: ~0 ~/~~ Wastewater System: ~New ~ Upgrade Address: ~'/~ ~ ~ 'Z:~'7 ~~~ 9~ff~ ABSORPTION FIELD _Ph°ne: ~~ ~E~-~-/7~ JNO. of B~ooms: ~OeepTrench ~ Shallow Trench ~Bed ~Mound ~Other I Soil Rating: Total Depth from original grade: LEGAL DESCRIPTION i,~ GPD/Sq. F,. II`P- Lot: ~ Block: Subdivision: ' Depth to pipe bottom from original grade: Gravel depth beneath pipe Ft. '-- Ft. Townsh,~,~ ~ IRange: ~,~ J ec,,o.= Il Fill added above original grade: Gravellength: , ~ Ft. ~ '-- Ft. WELL: '~ ~New ~Upgrade :Gravelwidth: I Number of lines: Joistancebetweenlines: 5 ~ Ft. / I '~ Ft. Classification (Private,;A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Driller: ~,.;.~ Date Drilled:~/~ "~',*'S~atic Water Level:FL Installer:~,~ ~"..''~.." Date installe:/~/~ J J Casing Height Above Ground: Yield:/. ~ GPM ~umpSetat: ~, [,. ~ ~, ~,. TANK SEPARATION DISTANCES ~Septic ~ Holding ~ S.T.E.P. TO Septic Absorption Lift Holding 3ublic/Private Manufacture~ Capacity in gallons: From Tank Field Station Tank Sewer Lines ~(:// ~. / Material: Number of Compartments: Well / ~? ' /~¢ '~ '~ ~~ Surface ~ .-- LIFT STATION Water ~0~ ioO~ Lot Size in gallons: ~ Manufacturer: I Foundation J~ ~/ ~ ~-- -- "Pump on" level at: J"Pump o,",eve, ~t: J High water alarm at: Curtain ~ ~ .__ Pump Make & Model ~ Electrical Inspections performed by: Drain I Remarks: BENCH MARK kocation and Cescdpfion: J Assumed Elevatio~ ~ Ft. J ENGINEER'S SEAL Inspections performed by: Dates. let ~ , i 2nd ~Y~ ~ ~ t , ' .... ~";'~ Department of 'Healt~and Human 8erwces' approval ~.~2.. '-' Reviewed and approved by: ie: //- 2 3 -~ ,.'. ~ ~0~[s¢:5':k~. -'a,o...~.~- 72-013 (Re~'. 9/91) MOA 25 .~ Permit No. ~ ~C,/~, ~' Page ~ of '-~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: _ 72-013, A (2/91) MOA 25 7a~ ENGINEER'S SEAL · ~.~ OF ~. _ Permit No. ~ ~ CI ''~ O I (~' ~' Page ..::::t , of '--.~ Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ' ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, AlasKa 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: oI David R.. Dayton biO. 2205-E, 72-013 A [Rev. 9191) MOA 25 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930165 DESIGN ENGINEER:DAVID R. DAYTON, P.E. OWNER NAME:RUST WILLIAM K & OWNER ADDRESS:425 N. BENEWAH ST. NAMPA IO. 83651 DATE ISSUED: 6/18/93 EXPIRATION DATE: 6/18/94 PARCEL ID:05154123 LEGAL DESCRIPTION: PETERS GATE BLK 1 LT 3 LOT SIZE: 55321 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: I · .1;~'i~ ~ D~yt~n P.E. ' ~Ikmd~r St. Ch~i~i~c, Alnsl~ 99~67 I Z..,.o"r 9 I 9 U I~vid R.'Dmyton P.E. 20210 I:Nmslnr St. Chugtik, Alaska 99567 ~ z./z. '~ 7F Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST PERFORMED FOR: ',~/~ LEGAL DESORIPTION:~-~T~ /~,~M..' ( Township, Range, Section: SLOPE SITE PLAN 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Monitoring? /~/O/.,z~ Date: Gross Net Depth to Net Reading Date Time Time Water Drop ,, /o., z ,' ,/:5 ) q ~ PF. RCOLATION RATE ~, 7.- /mmul~$/inchl P£R¢ HOLE DIAMETER ~ /t TEST RUN BETWEEN '¢'- FT AND {--¢' FT COMMENTS ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST I,.,_ LEGAL DESCRIPTION: ~C,~1~ ! 1 2 3 4 5 6 7 8 9 ,~Township, Range, Section: SLOPE SITE PLAN 10 11 12 13 14 15 16. 17 18 19 2O WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? P E Depth Io Water After, ~'//~.,,~.~ Monitoring? /(./Q/J ~' Date: Gross Net Depth to Net · Reading Date Time Time Water Drop PERCOLATION RATE ~'~ ~ (m,nutesnnch) PERC HOLE DIAMETER TEST RUN BETWEEN ~ FT AND ~' FT COMMENTS PERFORMED BY: ~"~,~-~-/~l RF-_-~, I t~~~ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: ~/~C/~ 72-008 (Rev. 4/85) D. R. DAYTON, P.E., R.L.S. [~x~~~ Chugiak, Alaska 99567 20210 Donalar (907) ~x7~ 696-2417 June 16, 1993 Lot 3. Block 1, Peters Gate Subdivision Design Narrative The proposed well and septic system will serve a 3 bedroom home. The septic system will be situated parallel to the contours on a moderately steep lot (15% in the septic area) of 1.27 acres. The well will be in the Southease corner of the lot with the septic system in the Southwest corner. As the lot is large the separation distances can be maintained with no problems. The system will not have any significant impact on wells or septic systems on ad~qining lots. There will be no significant impact on drainage, or reserved areas. ~ DOC Co, clbl SULLIVAN WATER WELLS P.O. BOX fl70272, CHUGIAK, ALASKA 99567 · TELEPHONE 688-2759 OWNER OF LAND "~ jot) {~g,~{}~ ADDRESS c~.,~CR"~' ~t~~ LEGALDESCRI~ION ~T- ~ ~ I DA~E- Sta~ed Ended PE~IT N~MBER DEl'TH OF WELL ~ STATIC LEVEL OF WATER FT. ,/<'~c,.~J~ DRAB' DOWN FT. GALS. PER HR KINl) OF CASING KIND OF FORMATION: From 0 ! Et. to &' FI. C~}~[~ ~,['"~"C~Op From _ ~ Ft. to ~ ..FI. ~)E~o,q~.. From ~' Et. to 3~ FI. ~0~ 6~OO~'C From~Ft. to~FI. ~e~/~~ ' ' From. From. From~ From__ From From From From__Ft. to .. FI, 0~ ~ From_2OO_Et. to 4qa F~.~,~/~OC-,¢ From Ft. to. , Ft. Er6m _~_O Fi. to 4~ FI. 'b~_~lOC. C Fr~m. Ft. to Ft.._~ ~'~ ~ 'F,omqfb Et. to 45'S"F~._/~V,*~ ~: From Ft. to From['~'~'"Ft. to .~ From ~ b FT" rrom~ g ~__~X} ,, From.~ From From ~,I /stq '~ From F,. F~~ ~o !0.~ From, , .Ft. to , Fl. Ft. to__Ft. .Ft. to__Ft. Ft. to .Ft. Ft. to , Ft Ft. to Ft. FI. to Ft. Ft. lo ,Ft. Ft. to Ft. Ft. to Ft. Ft. to , Ft. Et. to ,Ft Et. to Ft. Fi. to Ft. ELto__Ft. Et. to Ft. Et. to . Ft. MISCL. INFORMATION: 4a ,' c.. //ob s z}~,Os · ' DRILLI~R'S NAME MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # GENERAL INFORMATION Complete legal description Location (site address or directions) Property owner -'-~ Mailing address 2_ Lending agency Mailing address Day phone (; ,::t'~-.5"/73 Day phone Agent Address Unless otherwise requested, HAA will be held for pickup. Day phone 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: NOTE: Individual well Community well Public water If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site NOTE: Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA#21 STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm D=-;?- P-. _n-_,,,t~-_ P.m Phone 20210 DonaIar St. Address ,,.....~.., ,.. .......... / ) / Engineer's signature ,/2 ,-,-~9./~ ~"~--~ Date /'/~//~'~ .-- - / DHHS SIGNATURE )~ Approved for -~ Disapproved. Conditional approval for bedrooms. .... bedrooms, with the following stipulations: Additional Comments By: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev, 1/91) Back MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: A. Well Data Well type '~EJ J,~T'~' Log present (Y/N) Total depth /'7 Parcel I.D. If A, B, or C, attach ADEC letter. ADEC water system number ~' Date completed 7 / c~ ~ Driller Cased to ~Z~ Casing height Wires properly protected (Y/N) Sanitary seal (Y/N) ')/ FROM WELL LOG Pump level1 '~, SEPARATION DISTANCES FROM WELL TO; Septic/holding tank on lot Absorption field on lot Public sewer main Sewer service line Date of test Static water level Well flow AT INSPECTION g.p.m, g.p.m. ; On adjacent lots ; On adjacent lots Public sewer manhole/cleanout Petroleum tank /oo + m WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria Date of sample: B. SEPTIC/HOLDING TANK DATA Collected by: Date installed ! ~ / ~1 '~ Tank size Cleanouts (Y/N) Y Foundation cleanout (Y/N) High water alarm (Y/N) Date of pumping /[//~ ~ ¥~ o,~:~ Compartments ~-- ¥' Depression (Y/N) Alarm tested (Y/N) Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot / To property line Surface water/drainage On adjacent lots / oo ~ Absorption field 4-o Foundation Water main/service line 72-026 (3/93)* Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) High water alarm level Meets MOA electrical codes (Y/N) "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water. Date installed Length ~ q" Total absorption area D. ABSORPTION FIELD DATA I o/~ Soil rating (GPD/Ft~) Width Date of adequacy test ,J{~/(~-~) '~YS~ Water level in absorption field before test Peroxide treatment (past 12 months) (Y/N) ~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / c> ~ To building foundation On adjacent lots_ Surface water Curtain drain Gravel thickness Cleanout present (Y/N) Results (pass/fail) On adjacent lots Cutbank System type Total depth ?/ Depression over field (Y/N) for After test If yes give date / C:)c:) -i-- Property line To existing or abandoned system on lot /,.~o,~ ~ Water main/service line Driveway, parking/vehicle storage area Bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on Signature Engineer's Name Date David R. Dayton P.E. 20210 Donatar St. Receipt Number _ c>~ ~"/'/z/c~ ~'~ ~_/0c~-''~ ~. of this inspection. Waiver Fee $ Date of Payment Receipt Number_ 72-026 (3/93)* Back COMMERCIAL TESTING ENVIRONMENTAL LABORATORY SERVICES & ENGINEERING CO. ......... RE~K)RT of ANALYSIS Chemlab Ref.# :93.6042-! Client Sample ID :L3 Bi PETERS GATE SUB. Matrix :WATER 5633 B STREET ANCHORAGE, AK 99518 TEL: (907) 562-2343 FAX: (907) 561-5301 Client Name :DAVID DAYTON, P.E. Ordered By :DAVID R. DAYTON Project Name : Project% : PWSID :UA WORK Order :73038 Report Completed :11/11/93 Collected :11/09/93 @ 10:00 Received :11/09/93 @ 13:15 Technical Director:ST~HEN,C. EDp ~ Released By :~ ~/~ / hrs. hfs. Sample Remarks: ROUTINE SAMPLE COLLECTED BY: D.R.D. Parameter QC Results Qual Units Allowable Ext. Anal Method Limits Date Date Init Nitrate-N 0.10 U mg/L EPA 353.2/300.0 10 11/10 CMR * See Special Instructions Above ** See Sample Remarks Above U = Undetected, Reported value is the practical quantification limit. D = Secondary dilution. ~ SGS Member of the SGS Group (Soci~t(~ G~n~rale de Surveillance) UA = Unavailable NA = Not Analyzed LT = Less Than GT = Greater Than ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA